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|  | PART IV PROGRAM SERVICE REVENUE AND OTHER REVENUE (STATE NATURE) |   | Program |   | Other | 
|  |   |   |   |   |   |   | service revenue |   | revenue | 
|  | (a) Fees from government agencies | . . . . . . . . . . . . . . . . . . . | . . . . . . . . . . . . . . | . . . . . . . . . . . |   |   |   |   | 
|  | (b) | . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | . . . . . . . . . . . . . . | . . . . . . . . . . . |   |   |   |   | 
|  | (c) | . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | . . . . . . . . . . . . . . . . . . . | . . . . . . . . . . . . . . | . . . . . . . . . . . . |   |   |   |   | 
|  | (d) | . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | . . . . . . . . . . . . . . . . . . . | . . . . . . . . . . . . . . | . . . . . . . . . . . . |   |   |   |   | 
|  | (e) | . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | . . . . . . . . . . . . . . . . . . . | . . . . . . . . . . . . . . | . . . . . . . . . . . . |   |   |   |   | 
|  | (f) Total program service revenue (enter here and on line 2) | . . . . . . . . . . . . . . | . . . . . . . . . . . . |   |   |   |   | 
|  | (g) Total other revenue (enter here and on line 11) | . . . . . . . . . . . . . . | . . . . . . . . . . . . |   |   |   |   | 
|  | PART V BALANCE SHEETS | If line 12, Part 1, and line 59 are $25,000 or less, you should complete only lines 59, 66, and 74 and, if you do not | 
|  | Use fund accounting, line 73. If line 12 or line 59 is more than $25,000, complete the entire balance sheet. | 
|  |   |   | 
|  | Note: Columns (C) and (D) are optional. Columns (A) and (B) must be | (A) Beginning of |   |   | End of year |   |   | 
|  | completed to the extent applicable. Where required, attach schedules should be | (B) Total |   | (C) Unrestricted/ |   | (D) Restricted/ | 
|  | year |   |   | 
|  | for end-of-year amounts only. |   |   |   | Expendable |   | Nonexpendable | 
|  |   |   |   |   |   | 
|  |   | Assets |   |   |   |   |   |   |   | 
|  | 45 | Cash — non-interest bearing |   |   |   |   |   |   | 
|  | 46 | Savings and temporary cash investments |   |   |   |   |   |   | 
|  | 47 | Accounts receivable  _______ |   |   |   |   |   |   |   | 
|  |   | minus allowance for doubtful accounts  ____________ |   |   |   |   |   |   | 
|  | 48 | Pledges receivable  ________ |   |   |   |   |   |   |   | 
|  |   | minus allowance for doubtful accounts  ____________ |   |   |   |   |   |   | 
|  | 49 | Grants receivable |   |   |   |   |   |   | 
|  | 50 | Receivable due from officers, directors, trustees and key |   |   |   |   |   |   | 
|  |   | employees (attach schedule) | . . . . . . . . . . . . . . . . . |   |   |   |   |   |   | 
|  | 51 | Other notes and loans receivable  ____________ |   |   |   |   |   |   | 
|  |   | minus allowance for doubtful accounts  ____________ |   |   |   |   |   |   | 
|  | 52 | Inventories for sale or use | . . . . . . . . . . . . . . . . . |   |   |   |   |   |   | 
|  | 53 | Prepaid expenses and deferred charges |   |   |   |   |   |   | 
|  | 54 | Investments — securities (attach schedule) |   |   |   |   |   |   | 
|  | 55 | Investments — land, buildings and equipment: basis  ____ |   |   |   |   |   |   | 
|  |   | minus allowance for doubtful accounts  ____________ |   |   |   |   |   |   | 
|  | 56 | Investments — other (attach schedule) |   |   |   |   |   |   | 
|  | 57 | Land, buildings and equipment: basis  _________ |   |   |   |   |   |   | 
|  |   | minus accumulated depreciation  ______ (attach schedule) |   |   |   |   |   |   | 
|  | 58 | Other assets  _____________ |   |   |   |   |   |   |   | 
|  | 59 | Total assets (add lines 45 through 58) |   |   |   |   |   |   | 
|  |   | Liabilities |   |   |   |   |   |   |   | 
|  | 60 | Accounts payable and accrued expenses |   |   |   |   |   |   | 
|  | 61 | Grants payable |   |   |   |   |   |   | 
|  | 62 | Support and revenue designated for future periods |   |   |   |   |   |   | 
|  |   | (attach schedule) |   |   |   |   |   |   | 
|  | 63 | Loans from officers, directors, trustees, and key employees |   |   |   |   |   |   | 
|  |   | (attach schedule) | . . . . . . . . . . . . . . . . . |   |   |   |   |   |   | 
|  | 64 | Mortgages and other notes payable (attach schedule) |   |   |   |   |   |   | 
|  | 65 | Other liabilities  ___________ |   |   |   |   |   |   |   | 
|  | 66 | Total liabilities (add lines 60 through 65) |   |   |   |   |   |   | 
|  |   | Fund Balances or Net Worth |   |   |   |   |   |   | 
|  | Organizations that use fund accounting, check here   |   |   |   |   |   |   | 
|  | and complete lines 67 through 70 and lines 74 and 75. |   |   |   |   |   |   | 
|  | 67 a. Current unrestricted fund |   |   |   |   |   |   | 
|  |   | b. Current restricted fund | . . . . . . . . . . . . . . . . . . |   |   |   |   |   |   | 
|  | 68 | Land, buildings and equipment fund |   |   |   |   |   |   | 
|  | 69 | Endowment fund | . . . . . . . . . . . . . . . . . |   |   |   |   |   |   | 
|  | 70 | Other funds (Describe  _________ ) |   |   |   |   |   |   | 
|  | Organizations that do not use fund accounting, check here   |   |   |   |   |   |   | 
|  | and complete lines 71 through 75. |   |   |   |   |   |   |   | 
|  | 71 | Capital stock or trust principal |   |   |   |   |   |   | 
|  | 72 | Paid-in or capital surplus |   |   |   |   |   |   | 
|  | 73 | Retained earnings or accumulated income |   |   |   |   |   |   | 
|  | 74 | Total fund balances or new worth |   |   |   |   |   |   | 
|  | 75 | Total liabilities and fund balances/net worth |   |   |   |   |   |   |